Tag Archives: athletic training

It’s not often I completely take a post from another, but Mr. Yusuf Boyd, of Biomechaniks in Tennessee and North Carolina wrote a post last week that was on point! While I do not agree with everything in the post, what he says has a lot of merit and is worthy of a share.

I love Athletic Training and my fellow Athletic Trainers, but honestly this is the whiniest group on the face of the planet. March is National Athletic Training month; slogans fill my twitter feed: “I love my Athletic Trainer”, “Athletic Trainers’ save lives”, “My Athletic Trainer has my back.” Great, I am glad we are a prideful bunch, but enough of this holier-than-thou attitude. All I hear is “I am a Certified Athletic Trainer! I deserve respect!” It sounds like a crying toddler who didn’t get a lollipop from the dentist.

This very profession that demands respect also has many of its constituents complaining about the BOC’s new Evidence Based Practice CEU requirements. Really, you want more respect, but will moan and complain when our certifying agency and association wants higher standards? Continue reading →

I have written about knee injuries so much. Every day we are bombarded with research that quite frankly, it gets boring. The problem is with approximately a quarter-million ACL injuries per year, it is safe to say the injury is rampant. The devastating nature and commonality of the injury has provided loads of information on prevention, rehabilitation and mechanisms of injury. I am not going to regurgitate them all, but do want to share some recently published articles that sports medicine experts should read.

I love systematic lit reviews and this SLR aimed to determine postural control on those with ACL injuries. We have many internal systems and senses that help us balance. Beyond the use of our eyes and ears to sense balance, tiny mechanoreceptors and proprioceptors exist in our tissue that sense abnormal movement. This study found that when the eyes are closed individuals with ACL injuries had increased postural sway and loss of balance. This indicates that the injury and inflammation following injury inhibits our body’s internal mechanism to sense balance. When rehabilitating, be sure to emphasize proprioception exercises.

Despite advances in rehabilitation and the numerous studies published on ACL rehabilitation protocols, we appear to be failing. This study shows that at 6 months Status Post ACL reconstruction that global weakness still exists. When comparing strength output from injured vs. uninjured legs it appears the knee-extensors (quads) and knee flexors (hamstrings) are weaker at 6 months when compared to the contralateral side. Conversely hip and ankle strength was not significantly different at 6 months. The timeline to return a player back to competition and activity is 6 months following activity and/or 95% strength of the uninjured side. This study indicates 6 months might be too early. Also, we may need to adjust our strengthening protocols to further stress knee flexion / extension strength.

Darin Padua and the UNC Department of Exercise and Sport Science has done a lot of work on knee displacement and correlating the findings with ankle hypomobility and hip underactivity. This particular model used the NASM Corrective Exercise Model as the intervention procedure. This method systematically turns off hyperactive tissue and activates hypotonic tissues. The data revealed that following intervention of the ankle and hip medial knee displacement was significantly reduced. This information is important as several studies have shown medial knee displacement to be a primary cause of ACL injuries and chronic knee pain.

The inability of the body to absorb and control joint movement during high levels of ground reaction forces has been shown to increase risk of ACL injury as well as other chronic knee conditions. This study evaluated the effect of expert provided and self-analysis feedback reduced peak ground reaction forces. This is not a paramount study but does shows the effectiveness of verbal queuing and observation to correct suboptimal neuromuscular control, specifically during landing and absorption of ground reaction forces through the kinetic chain. Rehab practitioners should incorporate feedback to teach clients appropriate muscle control during ACL rehabilitation.

I would like to say thank you to Darin Padua, PhD, ATC for keeping me abreast with current data. Darin is a leader in sports medicine research and specifically has many published papers on ACL injuries. Darin manages his blog site and also shares info on his twitter account. If you are a health and wellness professional seeking important information rehabilitation and prevention of injury, I recommend you give Darin a follow.

Sharing a breakdown of what I have discovered and read this past month. There is a little something for everyone here. Although there is a lot out there, these four articles (2 sports medicine, 2 performance) are my favorites. All have something unique, progressive or surprising about them. Enjoy!

Sports Medicine:

Muscle Force Output and Electromyographic Activity in Squats with Various Unstable Surfaces, from the latest JSCR.

When progressing through rehabilitation programs the practitioner consistently battles the question of priority: improve strength and risk pain, set-back? Do we focus on balance and have slow progression to strength development? Can we super-set strength with balance? Can we go hard strength one day and light balance the next? Here’s a novel idea (sarcasm), let’s do both at once.

Saeterbakken and Finland measured muscle force output through on stable and unstable surfaces. The measurement was done through surface EMG, and, yes, I question reliability of surface EMG, but it is the best option out there. What the authors found was surprising and useful. Performing isometric exercise on an unstable surface (BOSU Ball) produced lower force output, but muscle in the trunk and lower limb was similar when compared to the stable surface.

Why is this important? We have a solution to the aforementioned dilemma. We can overload the muscle to stimulate strength gains, while avoiding the load. This allows practitioners to meet obtain strength gains while avoiding the risk of set-back associated with high loading.

Assessing Post-surgical ACL Postural Control using a Wii Board was an article I came across Sports Med Research BlogSpot.

At first I was tepid on this article figuring it was just another article showing how Wii can be used as a modality to improve balance control. I quickly jumped to the conclusion and began saying “people, it’s not the Wii board; it’s the task of balancing and stressing local and global neuromuscular control mechanisms to improve postural control.” To my surprise I was wrong.

The authors did something rather unique and plugged the Wii board in to a laptop and utilized a customized software program to assess postural control. The authors received high-quality data that may help clinicians objectively quantify postural control and neuromuscular inefficiency. Few assessments exist that provide objective, reliable data. I would love to see the authors do another study to examine the specificity and sensitivity of assessment.

EFFECTS OF COMBINED CREATINE AND SODIUM BICARBONATE SUPPLEMENTATION ON REPEATED SPRINT PERFORMANCE IN TRAINED MEN, from the latest JSCR.

When working with athletes on maximal speed or speed endurance, human physiology is our biggest limiting factor. Training allows body adaptation and physiological changes to improve performance and curb fatigue, but physiology is physiology – it can only be altered so much. Thus, supplements exist to cheat human physiology.

This study examines the combined effects of creatine and sodium bicarbonate (to retard acidic effects) supplementation of sprint performance. To no surprise the authors found that the combination of these supplements increased peak / mean power and attenuated the decline in power. Alas, we found a way to cheat human physiology.

A study done a few years ago demonstrated static stretching reduced power output and performance. Since then, there has been a lot of debate and negative press on static stretching on maximal voluntary contraction (MVC). Suddenly performance experts are saying “Static stretching is the worst thing you can do.”

This is not true! First the performance declined occurred after 45 second static holds. When a stretch was held for 30 seconds or less – as recommended – there was no performance loss. This was supported by a systematic literature review done Kay and Blazevich, published in Medicine and Science in Sports and Exercise last year (Jan 2012). This current study examined effects of Proprioceptive Neuromuscular Facilitation and static stretching on Maximum Voluntary Control.

Unfortunately, the static stretch protocols were to perform static stretches for 5 repetitions of 45 seconds. These parameters exceed the recommended static stretching variables of 2 sets of 30 seconds. As expected the authors came to the same conclusions – that static stretching decreased MVC. Although this is a good study, you must take the data for what it is. Static stretching reduces MVC if the stretch variables is held for 45 seconds. Before you start knocking static stretching understand the data you are interpreting.